Chapter 48: Caring for Clients with Ostomies
A client is recovering from the creation of an ileostomy due to complications of a bowel disorder. The client has a history of arthritis and takes daily medication to reduce inflammation. Which medication will the health care provider avoid prescribing?
sustained-release tablets
The nurse applies the ostomy appliance to a client who is recovering from ileostomy surgery. Which intervention should the nurse keep in mind to avoid any leakages from the appliance?
Ask the client to remain inactive for 5 minutes.
A nurse is providing discharge instructions for a patient with a new colostomy. Which of the following is a recommended guideline for long-term ostomy care?
Increase fluid intake, preferably of water, daily.
A nurse is documenting the appearance of feces from a patient with a permanent ileostomy. Which of the following would she document?
"Ileostomy bag half filled with liquid feces."
What would be characteristic of an unhealthy stoma?
protrusion beyond 2 inches from the skin
The nurse is caring for a client who received a Brooke ileostomy five days ago. The nurse, when assessing the ileostomy site, notes that the stoma appears to be extending out from the client's skin by approximately 1 inch. What is the nurse's best action at this time?
Contact the health care practitioner immediately and report the finding.
A nurse is teaching a client who has undergone a colostomy procedure as depicted in the accompanying image. What type of feces should the client expect to manage?
Semi-mushy
For 3 weeks, a client's stoma was draining adequate amounts of stool. Several days ago, the nurse began to notice that the client's intestine has begun to telescope through the stoma. The nurse suspects which of the following?
Stomal prolapse
A nurse is caring for a client with chronic ulcerative colitis who is scheduled to have surgery to create an ileoanal reservoir. How would the nurse describe this procedure?
An ileoanal anastomosis is performed in two stages. A temporary ileostomy is performed in the first stage, and 2 to 3 months later, the surgeon closes the temporary ileostomy and reunites the two sections of ileum.
The LPN/LVN is reinforcing preoperative teaching for a client who will be having a Brooke ileostomy and knows that the client must stop taking which home medications prior to the day of surgery? Select all that apply.
Aspirin Prednisone Cyclosporine
A nurse is caring for a patient with a colostomy. What type of stools would she expect to find in the colostomy bag?
Formed
The nurse is talking to the client about the procedure for changing an ostomy appliance. Which client statement indicates that the client understands the best time for scheduling this procedure?
I will change it before eating breakfast because there is less chance of spilling feces from the stoma at this time."
A male client has struggled for many years with Crohn's disease and has finally decided to have an ileostomy with hopes that this will improve the quality of his life. The nurse knows that which procedure will give the client the greatest chance of maintaining normal sexual function?
Ileoanal anastomosis
A nurse is providing education to a client with a continent ileostomy. The client asks what should be done if the catheter is obstructed. What would not be included?
Notify health care provider if unable to obtain drainage after 12 hours.
A client with an ileostomy calls the nurse to report that she is experiencing abdominal cramps, vomiting, and watery discharge from her ileostomy. The nurse should:
Notify the physician immediately.
The nurse is caring for a client with a Brooke ileostomy and should know that what laboratory tests will be ordered on a regular basis for this client
Potassium and sodium levels
The nurse is caring for a client with a Brooke ileostomy and should know that what laboratory tests will be ordered on a regular basis for this client?
Potassium and sodium levels
A nurse is teaching a client how to irrigate his colostomy. The nurse informs the client that the colostomy should be irrigated for which of the following reasons?
Regulate the timing of bowel movements
The nurse is caring for a client with severe ulcerative colitis who will be having the diseased portion of the colon removed and an ileostomy placed. The nurse knows that the client will be seen by the surgeon and which professional prior to surgery to decide the best position for the stoma?
Enterostomal therapy nurse
A nurse is performing an assessment on a client who has returned from colostomy surgery. What action would not be included?
Take the client's temperature via the rectal route and report a sudden elevation in temperature over 101°F.
The nurse is preparing a client for surgery where a Brooke ileostomy will be placed. The nurse assists the client to understand that this type of ostomy handles the passage of stool in what way?
The client must wear an external pouch and fecal contents drain directly into the pouch.
A patient with a diagnosis of colon cancer has required the creation of an ostomy following bowel surgery. What factor is most likely to influence the patient's adjustment to this change?
The coping mechanisms that the patient possesses
The nurse is assessing an older client with an ileostomy who states that the fecal matter coming from the stoma has been at a much greater quantity than usual for the last three days. The nurse is concerned that the client is dehydrated but because of lack of subcutaneous fat, the client's skin is already tented. The nurse will assess the client's fluid status by observing what other part of the client's body?
Tongue
A client had a colostomy placed 30 years ago and is experiencing difficulties with constipation. As recommended, the client has increased fluid intake, which has slightly lessened the symptoms, but the client remains constipated. What is another intervention that might make elimination easier?
Eat regular meals.
A nurse is assisting a client when he is draining a continent ileostomy. The catheter suddenly becomes plugged with stool. Which of the following actions should the nurse take to rectify the problem?
Rotate the catheter tip inside the stoma.
A client is scheduled to have a conventional ileostomy. A conventional ileostomy involves the removal of:
the entire colon and rectum.
Due to a lengthy history with Crohn's disease and the severity of symptoms, a client is being prepared for a colostomy. Which would be included in this client's individual care plan?
All options are correct.
The type of stool that will be expelled into the ostomy bag by a client who has undergone surgery for an ileostomy will be:
Liquid consistency
When is the best time to irrigate a colostomy?
after meals
A nurse is assessing the stoma of a patient with an ostomy. What would the nurse assess in a normal, healthy stoma?
dark red and moist
A client who has undergone colostomy surgery is experiencing constipation. Which intervention should the nurse consider for such a client?
Dilate the stoma with a lubricated, gloved finger.
A client with a new colostomy tells the nurse she thinks she is ready to learn how to care for it. Which of the following interventions would most likely be effective in preparing the client to look at the colostomy?
Show the client pictures that illustrate how a colostomy looks and functions.
What is the most common type of colostomy that needs to be irrigated to help promote regular evacuation of feces?
Sigmoid colostomy
In a client with an ileoanal reservoir, perineal exercises involve tightening the anus and holding the contraction for a count of how many seconds before relaxing?
10
A nurse is reviewing postoperative interventions with a client who recently received a colostomy. The client asks what should be done if there is leakage around the ostomy pouch. What advice would the nurse provide?
Change the ostomy pouch.
The nurse is reviewing an upcoming colostomy procedure with a client. What type of ostomy procedure will the client be undergoing based on the accompanying diagram?
Descending colostomy
Which of the following measures would the nurse recommend to an ostomate to help facilitate a regular bowel pattern without relying on irrigation? Select all that apply.
Drinking prune juice Performing mild exercise Using a stool softener
The nurse is caring for a client who has had a sigmoid colostomy. The client has expressed opposition to using irrigation as a regular way to regulate bowel elimination. What suggestion would help the client achieve this goal?
Increase the amount of fresh and dried fruits that are eaten on a daily basis.
The type of stool that will be expelled into the ostomy bag by a client who has undergone an surgery for an ileostomy will be:
Liquid
A client received a continent ileostomy 10 days ago, and the surgeon is removing the ileal catheter today. How often should the client empty the reservoir?
every 2 to 4 hours
A client underwent a continent ileostomy 2 months ago. How often should the client's reservoir be emptied?
every 2 to 4 hours
A nurse refers a patient with a new colostomy to a support group. This nurse is practicing which of the following aims of nursing?
facilitating coping
The nurse is talking to a client who had a colostomy 4 months ago. The client is complaining that her stools are not passing very easily and is afraid that the cancer that caused the need for the colostomy has returned. Which statement by the client would help the nurse to know why the client is experiencing this problem?
"I am currently on a diet to try and lose weight but the foods I eat are high-fiber."
The nurse is caring for a client who had a Loop Transverse colostomy performed because of a rupture of the colon from a diverticulitis abscess. The client asks the nurse when all of this will be over and life will return to normal. What is the nurse's best response to this client?
"I think you may mean when the colostomy will be reversed. It all depends on how soon your colon heals but it's usually about two to three months."
A client who underwent a colostomy is discussing lifestyle changes with the nurse. Which of the following statements from the client indicates a need for more teaching?
"I will never be able to travel outside the country again."
Which of the following statements about ostomy irrigation is true?
For some patients, regularly scheduled colostomy irrigation can be used to establish a predictable pattern of elimination.
The nurse is teaching the client how to effectively drain the continent ileostomy. Which statement by the client indicates that the client needs further instruction?
"Once I push the catheter into the stoma I should stop once I meet resistance."
A common nursing diagnosis for a patient who had a colostomy surgically created 6 months ago would be:
Ineffective Coping impaired due to colostomy
The nurse is caring for a client who recently had a Brooke ileostomy and will place priority on what aspect of physical assessment?
Skin integrity
The nurse is discussing with a client who has had a colostomy for approximately 6 months how he is doing with managing it. He replies that he feels very comfortable with taking care of it and completing the irrigations but he hates the terrible odor of the stool. The nurse will recommend which foods for the client to consume which may help in decreasing this odor? Select all that apply.
Yogurt Cranberry juice Buttermilk
When an appliance is necessary to collect stool from an ostomy, what primarily determines the consistency of the stool that is collected?
intestinal placement of the stoma
During client education with a client who has recently had an ostomy created, the nurse discusses the importance of skin care and maintaining skin integrity around the stoma. What type of appliance is most appropriate for the immediate postoperative period
temporary
A nurse is preparing a client who needs to have a colostomy procedure. What type of procedure is the client about to undergo based on the accompanying image?
Transverse colostomy
A client is in the postoperative phase of an abdominal resection and colostomy. When educating the client on his ostomy care by providing him with educational materials to read, it is important to assess the client's:
Vision
A client who underwent a colostomy reports a change in the appearance of his stoma. When the nurse asks for more information, the client says, "I was very upset about some family trouble, and my stoma became deep purple and oozed." How would the nurse respond?
"This is normal as long as the stoma has returned to its usual appearance."
In which part of the colon would the nurse expect to see a double-barrel colostomy?
transverse
A client is receiving postoperative instruction on how to release stool from a newly placed continent ileostomy. Which steps would be included? Select all that apply.
Sit on or beside the toilet, or on the side of the bed. Warm the catheter to body temperature and lubricate the tip.
A nurse assessing a patient with an ostomy appliance documents the condition "prolapse" in the patient chart and notifies the physician. Which of the following statements describes this condition?
The stoma is protruding into the bag and may become twisted.